Predictors of incomplete response to therapy among Filipino patients with papillary thyroid cancer in a tertiary hospital.

BACKGROUND: Although survival rate in papillary thyroid cancer (PTC) is high, the risk of persistence and recurrence together with the dramatic rise in its incidence cannot be overemphasized. Filipinos are considered to be at greater risk for negative outcomes. A paradigm shift in the management of PTC introduces re-stratification based on response to therapy which was reported to have better correlation with long-term outcome. The study aimed to identify predictors of incomplete response after thyroidectomy and radioiodine therapy among patients with PTC. The results of the study may have important implications in our understanding of the disease process allowing more aggressive treatment and monitoring of certain subgroups of patients. METHODOLOGY: Retrospective review of 225 patients with PTC (59% ATA low risk, 30 % ATA intermediate risk and 11% ATA high risk) who underwent thyroidectomy and radioiodine therapy was performed. Thirteen variables were considered (age, gender, histopathological variant, stage, extent of disease, MACIS score, AMES score, primary tumour size, lymph node, lymphovascular invasion, bilaterality, multifocality and preoperative TSH level). Logistic regression analysis using Backward Wald algorithm was used to identify independent predictors of incomplete response to therapy after 24 months. RESULTS: Of the 225 patients, 69 (31%) had incomplete response. Biochemical and structural (predominantly thyroid bed, lung and bone) incomplete response was observed in 6 and 63 patients, respectively. Incomplete response was documented in 8, 54 and 92% of low-, intermediate- and high-risk patients based on ATA recommendation. Incomplete response was significantly dependent on gender, lymph node involvement and location, extent of malignancy and multifocality taking into account the size of concurrent tumours (p < 0.05). The model was found to have high sensitivity (71%) and specificity (96%). CONCLUSION: A significant fraction of PTC patients experienced incomplete response to therapy. Our data suggest that male gender, lateral or mediastinal lymph node involvement, class III extent of disease by De Groot and multifocality with concurrent tumour or tumours more than 1 cm are major predictors of incomplete response. Not all predictors of recurrence and mortality are consistent predictors of treatment response which may be equally important in a disease with low mortality but significant morbidity like PTC.

Visualization of the liver with 99mTc-EHDP in thalassemia major.

A case is reported in which substantial liver uptake of 99mTc-hydroxyethylidene diphosphonate (99mTC-EHDP) was seen on bone scan. The patient, a 25-year-old male with the diagnosis of thalassemia major made at the age of 3 years, had received regular blood transfusions over many years. Clinical and laboratory evidence of hemosiderosis suggests that the presence of large quantities of iron in the liver of this patient may have been responsible for the hepatic uptake of the bone scanning agent.

Visualization of a malignant pericardial effusion with Tc-99m-EHDP.

Increased accumulation of radioactivity in a pericardial effusion was observed on a routine bone scan in a patient with known primary breast and lung carcinomas. A dynamic flow study and echocardiography confirmed the presence of the effusion. Microscopic examination of the pericardial fluid revealed the presence of malignant cells.

Decreased bone uptake of technetium-99m polyphosphate in thalassemia major.

Bone scans were performed with Tc-99m stannous polyphosphate on four patients with thalassemia major. Three of the scans show generalized decrease in skeletal uptake of the radiopharmaceutical, associated with renal enlargement and markedly increased renal radioactivity. The skeletal findings are consistent with the known bone abnormalities in thalassemia major, which are secondary to the extensive marrow hyperplasia and include loss of trabeculae and cortical thinning with consequent loss of bone mass. The increased renal uptake is probably due in part to the increased renal excretion (secondary to the poor bone uptake) and in part to the tubular dilatation and renal enlargement associated with thalassemia major. In addition, the presence of excessive amounts of iron in these patients may play a role in both the skeletal and renal findings.

Adenosarcoma of uterus and ovary: a clinicopathologic study of two cases.

We report the clinical and pathologic features of two cases of adenosarcoma. Our first case occurred in the ovary of a 51-year-old woman with extensive pelvic involvement. She was treated vigorously with radiation and chemotherapy and at the present time almost 9 years later the patient is free of disease. This represents a case with one of the longest survival reported in the literature. Our second case occurred in a 37-year-old woman and was limited to the endometrium.

Metastatic calcification in lungs and stomach demonstrated on bone scan in multiple myeloma.

A case of multiple myeloma with associated intense radionuclide uptake in the lungs and stomach on bone scan is presented. There was no roentgenographic evidence of calcification, and the bone scan provided the only antemortem evidence of metastatic calcification.

Granulomatous hepatitis: spectrum of scintigraphic manifestations.

Four cases of granulomatous hepatitis are presented. Hepatocellular disease in general and the clinical, histological and scintigraphic manifestations of granulomatous hepatitis are discussed.

Demonstration of superior vena caval obstruction and "hot spot" on liver scan in a case of non-Hodgkin's lymphoma.

A case of total superior vena cava obstruction and "hot spot" in the liver demonstrated by a radiocolloid liver scan in a case of non-Hodgkin's lymphoma of the anterior mediastinum, is presented. The study showed total obstruction of the superior vena cava and the presence of collateral circulation. The patient received radiation therapy, and a subsequent radiocolloid study showed relief of the obstruction and disappearance of the "hot spot."